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(Circulation. 2005;112:2904-2911.)
© 2005 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Chronic Atrioventricular Nodal Vagal Stimulation

First Evidence for Long-Term Ventricular Rate Control in Canine Atrial Fibrillation Model

Youhua Zhang, MD, PhD; Hirotsugu Yamada, MD, PhD; Steve Bibevski, MD, PhD; Shaowei Zhuang, MD; Kent A. Mowrey, MS; Don W. Wallick, PhD; Seil Oh, MD, PhD; Todor N. Mazgalev, PhD

From the Department of Cardiovascular Medicine, The Cleveland Clinic Foundation (Y.Z., H.Y., S.Z., K.A.M., D.W.W., S.O., T.N.M.), and Department of Physiology and Biophysics, Case Western Reserve University (S.B.), Cleveland, Ohio.

Correspondence to Todor N. Mazgalev, PhD, Research Institute FF1-02, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail mazgalt{at}ccf.org

Received April 13, 2005; de novo received June 14, 2005; revision received August 18, 2005; accepted August 26, 2005.

Background— We have previously demonstrated that selective atrioventricular nodal (AVN) vagal stimulation (AVN-VS) can be used to control ventricular rate during atrial fibrillation (AF) in acute experiments. However, it is not known whether this approach could provide a long-term treatment in conscious animals. Thus, this study reports the first observations on the long-term efficacy and safety of this novel approach to control ventricular rate during AF in chronically instrumented dogs.

Methods and Results— In 18 dogs, custom-made bipolar patch electrodes were sutured to the epicardial AVN fat pad for delivery of selective AVN-VS by a subcutaneously implanted nerve stimulator (pulse width 100 µs or 1 ms, frequency 20 or 160 Hz, amplitude 6 to 10 V). Fast-rate right atrial pacing (600 bpm) was used to induce and maintain AF. ECG, blood pressure, and body temperature were monitored telemetrically. One week after the induction of AF, AVN-VS was delivered and maintained for at least 5 weeks. It was found that AVN-VS had a consistent effect on ventricular rate slowing (on average 45±13 bpm) over the entire period of observation. Echocardiography showed improvement of cardiac indices with ventricular rate slowing. AVN-VS was well tolerated by the animals, causing no signs of distress or discomfort.

Conclusions— Beneficial long-term ventricular rate slowing during AF can be achieved by implantation of a nerve stimulator attached to the epicardial AVN fat pad. This novel concept is an attractive alternative to other methods of rate control and may be applicable in a selected group of patients.

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